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#Get PT 1st For Back Pain

Chances are, you or someone you know has had back pain. Each year 15% of the population has their first episode of back pain, and over the course of our lives, 80% of us will have back pain. Even though back pain is common, the medical community does a poor job managing it.  Stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability are far too common.

Let’s look at some of the common treatments for low back pain and see how they stack up against physical therapy:
Medication Low back pain is the #1 reason for opioid prescription in the US, however in 2106, the CDC recommended against the use of opioids for back pain in favor of “non-drug treatments like physical therapy.”

Imaging

Having an X-ray or MRI for back pain is common, however it’s rarely needed or helpful.
Research has NEVER demonstrated a link between imaging and symptoms. As we age,
degenerative changes on imaging is common.
● 90% of people age 50 to 55 have disc degeneration when imaged, whether they have
symptoms or not
● In 2015 a study that looked at 1,211 MRI scans of people with no pain found that 87.6%
had a disc bulge
● Just getting an image increases the chances that you’ll have surgery by 34%

Surgery

The US has sky high rates for back surgeries – 40% higher than any other country and 5x higher
than the UK. You’d think that with all the back surgeries we do, we’d be pretty good at it but the
outcomes are terrible!

A worker’s comp study looked at 725 people who had spinal fusions VS 725 people who didn’t.
The surgical group had:
● A 1 in 4 chance of a repeat surgery
● A 1 in 3 chance of a major complication
● A 1 in 3 chance of never returning to work again

Physical Therapy

● Current clinical practice guidelines support manual therapy and exercise
● Research proves that early PT lead to better outcomes with lower costs, and decreases the risk of surgery, unnecessary imaging, and use of opioids
● A study of 122,723 people with low back pain who started PT within 14 days found that it decreased the cost to treat back pain by 60%
● Unfortunately only 2% of people with back pain start with PT, and only 7% get to PT within 90 days.

Despite the data showing that PT is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. Almost every state has direct access, meaning that you can go directly to a physical therapist without a doctor’s referral. If you see your doctor for back pain, and PT isn’t one of the first treatment options, ask for it!

Snow Shoveling Tips

It’s that time of year again! According to the U.S. Consumer Product Safety Commission, more than 158,000 people were treated in emergency rooms, doctors’ offices, and clinics for injuries that happened while shoveling or removing ice and snow manually. Snow shoveling is a common cause for back pain and lumbar injuries, however there are ways to prevent these from occurring. Proper mechanics and technique can help decrease post-shoveling low back pain.

  •    Lift with your legs, not your back:  When shoveling snow we tend to bend forward putting a lot of stress on the lumbar spine, which increases the risk of injury or flare up of low back pain. In order to prevent this, try to squat down by bending at your knees lift the snow using your legs instead of your back.
  •    Turn with your feet: When we twist with our feet planted we are mostly twisting using our low back. A better way to turn with a heavy load is to keep the core tight and lock the arms into your side while pivoting using your feet. Using these mechanics will help decrease load on the spine and help prevent injury.
  •       Grip snow shovel with hands apart: Gripping the shovel with your hands together can create a longer lever arm, which in turn makes it harder to lift the shovel filled with snow. Having one hand toward the handle and one hand further down towards the shovel will improve force distribution and decrease stress on the body while snow shoveling. It will make the pile of snow seem like less than it is.
  •    Take breaks: Muscle fatigue can cause our mechanics to break down, putting us at risk for injury. Be sure to take plenty of breaks in order to keep your muscles in good condition and maintain good mechanics.
  •    Shovel smaller loads of snow: Only shovel a load you can handle while maintaining all the mechanics above. If the load is too heavy and compensations are occurring, your mechanics suffer. When mechanics suffer, the risk for injury increases. Only shovel loads you can handle!

Safe snow shoveling is important to prevent injuries that will affect the ability to participate in daily life. It is important to maintain proper mechanics and decrease risk of injury in order to stay healthy and active throughout the winter.

If you or someone you love are experiencing any aches and/or pains then schedule a FREE Screen with one of our Doctors of Physical Therapy.  No Prescription Necessary! 

Postpartum and Physical Therapy

Pregnancy is a long and beautiful process with each step a critical component to proper fetal development. Your body, which you have gotten used to for the past 20-30 years has now suddenly changed within a very short period. After pregnancy, during the postpartum period, it can sometimes be discouraging and exhausting to return to your pre-pregnancy body.  Let’s face it; taking care of a newborn is tough and difficult, no matter how many times you’ve been through it. Your body has gone through a traumatic event and every second is a new experience.  Taking care of yourself can be extremely difficult with a newborn, but it is during this time that your body is most vulnerable and susceptible to acute and chronic injuries.  With everything happening for your newborn, it can be easy to forget to take care of yourself!

Common problems postpartum

  • If you had a natural delivery, you may have had stitches and it is normal to have some discomfort with urination or sitting. If you had a c-section, the recovery process will generally take longer and you may have more precautions that your doctor will instruct you in. However, with either type of deliveries, you should not have to tolerate long term pain! Your physical therapist can help reduce any pain you may have and help you return to your normal lifestyle pre-pregnancy.
  • Back pain is a common problem as your center of mass has drastically changed in a very short amount of time. This gives your body less time to prepare for the shift in weight. Your body will move differently than it has in the past 9 months and it is vital to have proper guidance to return to activities.
  • Hip pain may also occur as natural delivery requires you to create extremely high pressure in an unfavorable position for your hips. In therapy, you can benefit from strengthening your hips, as well as decreasing pain.
  • Weakness in your core can be expected as your abdominals have been stretched. Again, this is common, but you should not have long term pain.
    • You may also have diastatis recti, which is a fancy term for increased gap between your middle abdominal muscles, called the rectus abdominus. This may be painful and you can see your physical therapist to help you with this.
    • Weakness in the pelvic floor can lead to urinary or bowel incontinence. If you have a uterine prolapse or rectocele, it is very important that you learn how to strengthen to muscles properly. A therapist specialized in pelvic floor can you regain proper control of these important muscles.
    • Postpartum depression – it took 9 months for hormones to develop in your body to have a healthy baby and in 2-3 days postpartum, the levels of hormones will reduce to pre-pregnancy base lines! Postpartum depression is a serious complication. Be sure to communicate with your doctor if you feel you have postpartum depression.
    • Joint pain is common because during pregnancy, your ligaments become lax to create space for the baby to come out of the birth canal. However, the hormones do not limit to only pelvic ligaments and will stretch out ligaments in your entire body. It is important to see a therapist to learn how to strengthen your muscles and avoid certain positions that could place your body at risk for further injury.

Choose PT first!

  • Your body changes drastically during pregnancy and you may benefit from the help of a physical therapist to get you back to the way you were prior to pregnancy
  • Don’t be okay with postpartum pain or body aches and think that is “normal.”
  • Don’t be scared to get back into physical activity
  • Taking care of yourself can be extremely difficult with a newborn but it is during this time that your body is most vulnerable and most susceptible to acute and chronic injuries

 

Physical therapy can benefit you!

  • Teach you about your body so you understand how to use muscles that have been overstretched or overused from changes in your body
  • Strengthen muscles to create proper stability in your body and core
  • Relieve pain

 

Taking Care of yourself while taking care of your child

  • When you carry your child, be careful of your posture. Try not to hike your hip up and use both arms.
  • When picking up your child, go into a proper squat and use your legs to lift. Your newborn might be a few pounds now, but they gain weight quickly!
  • If you are breastfeeding, try to use a pillow to prop your newborn instead of using your arms to keep him lifted

In the States, new mothers will meet with their doctors after 6 weeks to clear them for activities. Many times, mothers will be nervous about returning to exercises or think they will not have the time to exercise. Meeting with a physical therapist will allow proper guidance to return to you lifestyle, worry-free.

References:   Simonds, A. (2015, June 29). Evaluation and Management of Prenatal and Postpartum Clients in Physical Therapy. Lecture presented at Prenatal and Postpartum Lecture in Rutgers University , Stratford, NJ.

Make a SPLASH into Recovery

Spring is around the corner! With it comes the opportunity to participate in all of the exciting activities the season affords. Unfortunately, many individuals are unable to take full advantage of this warm weather due to chronic pain or other injuries that causes difficulty with movement and activity.  Being unable to engage in hobbies or activities you are accustomed to can lead to a decreased quality of life.

Thankfully, it is not too late to get back to performing the activities you, or someone you know, once loved. Aquatic Physical Therapy can aid in improving movement, decreasing pain, and restoring function for all daily activities. In this article, we will discuss how there is no better time to dip your toe in and try aquatic therapy at BREAKTHRU.

  • What is Aquatic Physical Therapy? 

Many individuals feel as if they have exhausted all options including physical therapy and must live with their pain.  This is simply not true. Aquatic physical therapy is distinctly different from land based physical therapy. In the water, buoyant forces push the body upwards, effectively causing you to “weigh” less. This results in less impact during activity and a decreased load on the joints, muscles, and bones.  Movement is easier and less painful than on land, and patients are able to perform exercises not possible out of the pool. Additionally, our pools have multiple massaging jets and are kept at a warm 90°F which provides relief to tight muscles, spasms, as well as decreasing pain.  

At BREAKTHRU, exercise programs are constructed individually for each patient to ensure the highest levels of success. The exercise program will be challenging, but manageable for you, and will work specifically to increase your endurance, strength, and flexibility. Most exercises that are performed on land can also be performed in the pool. Our aquatics facility has a plethora of water based exercise equipment including use of dumb bells and flotation devices.

Most notably, we uniquely offer an underwater treadmill that can be remotely controlled to reach the perfect, most comfortable speed for you. The treadmill allows individuals to walk, jog, or run in the water where they “weigh less.” Additionally, we also have the ability to provide gentle resistance through water based currents in the pool.  

At BREAKTHRU, our goal is to provide the highest quality care to patient’s during their path to recovery and fitness. To us, this means one-on-one care with a Doctor of Physical Therapy (DPT) is the utmost importance.  

You will be scheduled with the same PT at every visit which will allow him or her to get to know you and your health condition personally. The entire staff will make sure you are performing exercises correctly with proper form at the right dosage (reps, sets, and durations), as well as taking recommended breaks throughout.  

  • How can I get started?

FREE Screen: If you are unsure if aquatic therapy is right for you, it all starts with your FREE consultation with a Doctor of Physical Therapy. You can set up this FREE meeting at our Mt. Laurel location (Near the Whole Foods and LA Fitness) by calling (856) 722-1044 OR our Medford Fitness location by calling (609) 451-6582

Initial Evaluation: If you or someone you know could benefit from decreasing pain and moving better, you can see a Doctor of Physical Therapy by scheduling an initial evaluation. At the evaluation, your PT will take a detailed history of your condition by asking questions and listening to your story. He or she will then take a look at what impairments you may have (strength, flexibility, pain, motor control).  The process typically takes between 30-45 minute.  You will then meet the friendly staff, be given a tour of the facility, and scheduled for the first session.  

First session: will consist of becoming familiar with the pool, getting to know your physical therapist, and beginning your exercise program. A typical treatment session is around 1 hour in length and allows time for warm up on our underwater treadmill or massaging jets, as well as your exercise program and a cool-down.  At following sessions, your exercise program will be progressed appropriately in accordance with your plan of care and include more exercises that will benefit you.  

  • Who can benefit from skilled aquatic physical therapy?

Arthritis:Arthritis of the hip and knee are one of the most common diagnoses seen for aquatic therapy at BREAKTHRU.  Our patients are able to walk for longer distances on the underwater treadmill without pain. Additionally, physical therapy will strengthen the muscles of the lower leg, thigh, and glutes in order to decrease pain and improve strength. This will help take some of the stress off of your arthritic joint by allowing the muscles to stabilize and absorb force. Osteoarthritis is the most common form seen at our clinic, however water based therapy will improve function in RA as well.

Low Back Pain: Low back pain is the most common diagnosis seen in physical therapy and can cause patient’s difficulty in walking, bending, and lifting items. Additionally, some low back pain may even be felt in the legs and feet.  In the pool, the water can relax the low back muscles and the jets can help de-sensitize an area by providing gentle stimulus to the nerves.  Stretching can be performed in the pool. Additionally, we will work to strengthen the core in the water which will act as a “natural back brace” to strengthen your spine’s support.

 

 

Post Joint Replacement: A large amount of evidence exists through research studies supporting using pool based therapy following total knee arthroplasty (TKA) or total hip arthroplasty (THA). These patients can benefit from water based therapy when cleared by a surgeon. Walking can be performed for longer periods of time with less rests. Most exercises can be performed with decreased pain in the pool, which can provide relief to patient’s looking to get moving sooner. These patients will eventually progressed to land based exercises.

Sports related surgeries:  Athletes who suffer ACL, PCL, or Meniscal injuries requiring surgery are often braced for several weeks. Afterwards, they typically follow a protocol in place by a physician in order to return them to sport safely. Many protocols recommend water based jogging in order to begin loading the joint before beginning these activities on land, however most physical therapy centers do not have access to pools. At BREAKTHRU, we can begin jogging activities early in the pool, which allows the athlete to return to running and sport sooner. Additionally, jogging in the pool will keep the athlete at a high level of conditioning during their recovery.

 

General Deconditioning: The pool is a great way to begin physical therapy for individuals who lack strength or endurance in their legs or core.  These individuals may report getting tired with walking after a short distance, having difficulty going up or down stairs, or feel “weak” in the legs. Exercises can be initiated in the pool and progressed to improve strength. Water-safe weights can be incorporated into programs to challenge the patient. Once the patient has gained sufficient strength, physical therapy can begin on land. This is a great “stepping stone” to begin land-based physical therapy.

References:Waller B, Ogonowska-Slodownik A, Vitor M, et al. Effect of Therapeutic Aquatic Exercise on Symptoms and Function Associated With Lower Limb Osteoarthritis: Systematic Review With Meta-Analysis. Physical Therapy. 2014;94(10):1383-1395. doi:10.2522/ptj.20130417.
Barker A, Talevski J, Morello R, Brand C, Rahmann A, Urquhart D. Effectiveness of aquatic exercise for musculoskeletal conditions: a meta-analysis. Physiotherapy. 2015;101. doi:10.1016/j.physio.2015.03.250.
Prins J, Cutner D. Aquatic Therapy In The Rehabilitation Of Athletic Injuries. Clinics in Sports Medicine. 1999;18(2):447-461. doi:10.1016/s0278-5919(05)70158-7.
Schonewill A, Rogers K, Spear A, Weinberg D, Pitt R. Combined Effects of Aquatic and Land-Based Rehabilitation in Female Soccer Players Post ACL Reconstruction: An Overview of Current Evidence. Journal of Physical Therapy and Health Promotion. 2015;3(2):11-19. doi:10.18005/pthp0302001.
Villalta EM, Peiris CL. Early Aquatic Physical Therapy Improves Function and Does Not Increase Risk of Wound-Related Adverse Events for Adults After Orthopedic Surgery: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation. 2013;94(1):138-148. doi:10.1016/j.apmr.2012.07.020.

Your Spine Does Not Go Out Of Place

It is a common report in the physical therapy clinic that a patient’s spine or hips go out place. This belief is followed by a need for the patient to seek healthcare practitioners that can simply “put their bones and joints back in place” using manual force through joint manipulation or adjustment. This results in lifelong visits and dependency for continuous adjustments as the spine continues to go “in and out of place”. What if I told you that this concept of the spine going out of place is not true and has been scientifically disproven through multiple studies?

In actuality, your joints and bones do not easily move in and out place unless there is a large traumatic force causing a
dislocation, which is a medical emergency. This belief can be quite detrimental to patient recovery and facilitates a dependence on a healthcare professional, requiring monthly and sometimes weekly “adjustment” to put bones and joints back in place. In addition, having this belief creates a fear of movement which then causes avoidance of particular motions that ultimately hinder recovery. Both of these factors result in a worse prognosis for the patient and can actually do more harm than good. Our bodies are much stronger and more resilient than we think. Studies have shown that it takes over 1000 pounds of force to deform fascia (a connective tissue covering) by only 1%! Performing a joint manipulation/adjustment cannot come close to the amount of force to put a joint “back in place”.
Tullberg et al. performed a study on joint position in patients with one sided low back pain involving the sacro-iliac joint (better known as the SI joint). He performed joint manipulations/adjustments to the SI joint and measured the position of the joint pre- and post- manipulation to assess if the joint was moving in and out of place. The findings of the study were that there were positive changes in terms of pain, but no change in joint position in any of the participants of the study!
What patients are actually feeling when they perceive a bone or joint to be out of place is a combination of unilateral low back pain, a lack of muscle stability in the low back area and a reluctance of the body to fully bear weight on the affected side, secondary to pain. Joint manipulations can be a useful technique to decrease pain and improve movement, however, the effects are only temporary in nature leading to the need to be continuously “adjusted.” Patients who are experiencing low back pain actually require a combination of manual therapy techniques, such as manipulation, followed by specific exercise and strengthening techniques to address pain and weight bearing/muscle instability to facilitate long term changes in pain. There is a large growing body of evidence through research on the positive and sustainable impact that physical therapy has on patients with low back pain.
In conclusion, it is a scientific fact that your joints are unable to go in and out of place so easily and that the adjustments or manipulations received are a temporary change in pain. Our bodies are much stronger than we think and are capable of the long term changes. Patients with low back pain require appropriate strengthening and stability in combination with manual therapy techniques. Schedule an appointment with BREAKTHRU Physical Therapy and Fitness for a free consultation for assessment of the low back and the development of a treatment program aimed to reduce or eliminate your low back pain, teach independent management of your low back pain and to facilitate a return to normal activities that may be currently hindered by your pain!

 

-Dr. Brandon Fredhoff PT, DPT

Scoliosis and The Schroth Method

A Conservative Treatment Approach to Combat the Progressive Nature of the Condition

For far too long, individuals and their family members have expressed the feelings of helplessness, like “there is nothing that can be done” and are forced to adapt a “wait and see” approach as the only model of care after a loved one is diagnosed with scoliosis. This condition can present at any point in development, but onset typically occurs during the adolescent years, when growth and skeletal maturity are really starting to progress. Physical therapy over the years has not been considered as a “primary treatment option” for patients diagnosed with scoliosis, however evidence is being developed and global techniques which have been around for decades are being studied and introduced more frequently now more than ever. This is resulting in at least “options” for patients and their families as a means to combat this condition. Instead of “wait and see”, the mantra is shifting to “try and see”. The Schroth Method is one of these options that could be beneficial for you or a loved one who has been diagnosed with scoliosis.

The Schroth method is a cognitive & sensory-motor 3-dimensional approach to treating the scoliotic spine through trunk elongation and rotational breathing strategies to improve trunk and spinal imbalances. The goal is to strengthen and develop the inner muscles of the rib cage and torso in order to influence the shape of the unique spinal curve pattern of each individual patient, while also maximizing the patient’s postural awareness. This technique has been used in Europe for decades; however, only recently began growing in popularity in the United States.

There is growing evidence to support the need of incorporating scoliosis specific exercise techniques, or this “try and see approach”, to provide alternative options for patients and families who are not exactly sure what the future looks like or what to expect in regards to the “severity and progression of the curve”. The Scoliosis Research Society advocates that the goal of conservative treatment should be to “reduce the risk of a curve progressing to a point where surgery is indicated”1. It also acknowledges that recent evidence studying patients with mild scoliosis of 10-20 degrees revealed that scoliosis specific exercises may prevent curve progressions to further levels of deformity resulting in additional medical management, such as surgery.1,2

What are the Goals of Treatment?
• Correction of the scoliotic posture
• Stabilize the spine and arrest the curve progression
• Improve self-image
• Improve function
• Improve pain
• Improve respiration and lung function
• Improve confidence and empowerment over scoliosis

Who would benefit from the Schroth Method?
Although onset typically occurs in adolescence, patients of ALL AGES can benefit from this method of treatment. The exact strategy and approach is dictated by the unique curve patterns as well as levels of skeletal maturity; however The Schroth Method can be beneficial for patients in all stages of scoliosis. This includes patients who have not yet begun bracing, patient who are currently being braced, as well as pre-operative or post-operative treatment when surgery is indicated.

In addition, research on the Schroth Method and similar treatment strategies is also developing to evaluate the benefits and effectiveness on postural related spinal deformities for people of all ages.

What are the exercises like?
During each session, you will be guided through specific exercises designed for you based on the curve pattern, curve severity, age, overall health, and other factors. Your certified Schroth Therapist will provide extensive verbal and tactile cuing throughout each exercise to facilitate curve correction through appropriate muscle activation, spinal positioning and breathing patterns.

Team Approach is Essential:
Proper management of the scoliotic spine requires a successful multi-disciplinary team approach between the treating Physician, Schroth Therapist, Orthotist (when bracing is required), and family members. Our certified Schroth Therapists understand these relationships are essential and work closely with these health care providers in order to provide seamless care for the patients to achieve optimal outcomes.

Ask for the “Schroth Method” to schedule an evaluation with our certified Schroth Experts!

References:
1. https://www.srs.org/about-srs/quality-and-safety/position-statements/screening-for-the-early-detection-for-idiopathic-scoliosis-in-adolescents2. Monticone M, Ambrosini E, Cazzaniga D, Rocca B, Ferrante S: Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial. Eur Spine J (2014) 23:1204–1214

Chronic low back pain: You don’t have to live with it.

No referral is needed to see a Doctor of Physical Therapy.  Call us to schedule your consultation or use our convenient online form. South Jersey’s Best Physical Therapists will get you on the road to recovery and our experienced office staff will handle your insurance coverage.

Low back pain Facts

  • Low back pain is the 2nd leading cause of disability in the United States and one of the most common reasons for missed work time.
  • Up to 80% of individuals WITHOUT low back pain will show Positive Findings on medical imaging.
  • Up to 90% of low back pain cannot be diagnosed with medical imaging and is therefore called non-specific mechanical low back pain.

What is PAIN?

Everyone agrees that pain is a universal experience. Pain is 100% produced by the brain and is divided into two categories:

  • Acute Pain: Lasts a few days or weeks, is typically associated with tissue damage and people are often encouraged to stay active with progressions back to normal life.
  • Chronic Pain: Continues beyond healing times and typically requires skilled management.

How can someone with chronic low back pain reduce this “threat level” and improve their quality of living?

GET PT FIRST

The average cost is $2,736 LESS when a patient is referred to physical therapy as the first line of defense against low back pain.

  • Treatment of low back has evolved with greater emphasis on conservative treatment and less emphasis on MRI findings.
  • Invasive procedures (surgery, injections) for low back pain have shown to be no better than physical therapy at long term follow up.
  • Physical therapy interventions can include manual therapy techniques, lifestyle modifications and specific exercise.

Physical therapists are trained to determine the appropriate interventions based on examination and high quality research. Pain education (cognitive behavioral therapy) helps decrease disability and improves function in patients with chronic low back pain.

Physical Therapy Treatment at BREAKTHRU

Therapy at BREAKTHRU will consist of an individual treatment plan based on evaluation findings, subjective history, and patient individual goals. Treatment will consist of manual “hands on” techniques, specific exercises, pain education and ways to return to daily activities.

If you have been experiencing low back pain, consult one of our Doctors of Physical Therapy to determine an individual treatment strategy that’s best for you.